Investigation

Investigation in PMR is used to support the diagnosis as well as to rule out any other possible causes. BSR guidelines recommends the following investigations in polymyalgia rheumatica:

• ESR
  • usually raised and returns to normal with treatment
  • in some patients low or normal rates have been reported as well
• CRP
  • more sensitive marker
  • usually elevated (1)
• full blood count - reveals a normochromic, normocytic anaemia in many cases (2)
• investigations which should be carried out to exclude other conditions before starting steroid treatment include
  • rheumatoid factor (and anti-citrullinated peptide antibody if available) - negative
  • liver function
  • urea and electrolytes (1)
  • myeloma screen including protein electrophoresis and examination of urine for Bence Jones protein
  • thyroid stimulating hormone
  • calcium, alkaline phosphatase
  • creatine kinase
  • dipstick urinalysis
  • chest radiograph e.g., if prominent systemic symptoms
  • ANA (1)

Reference:

• (1) Dasgupta B et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010;49(1):186-90.
• (2) Mackie SL, Mallen CD. Polymyalgia rheumatica. BMJ. 2013;347:f6937.
• (3) Dasgupta B, et al. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol 2007;25(Suppl.47):s130-s136